Last week, when a non-English speaking woman arrived at the crowded emergency room of a Brooklyn hospital in New York, she was initially installed in a coronavirus-free patient unit.
On Thursday, however, a doctor realized that she had a fever and a cough, and that she should receive care for covid-19, so she transferred her to the coronavirus unit with a warning: “Good luck, she speaks Hungarian.”
The woman passed away the following night.
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A resident doctor who treated her believes she would have received better treatment if she had spoken English.
In the emergency room, where no one ever has enough time, let alone now, the resident said he observed that no one wanted to work with an interpreter to record the patient’s medical history. He himself placed his phone on the woman’s shoulder and called the interpretation service on the loudspeaker. It was difficult for him to speak and hear clearly due to the N95 mask and the helmet that covered his ears.
“When they asked me what language I needed,” he noted, “I spent five minutes screaming over and over,‘ Hungarian! Hungarian! ’The operator only answered: Español Spanish?’ ”
The patient could have died even if she spoke English, but this episode and others of the same nature demonstrate that people who speak other languages are disadvantaged in New York hospitals that are currently crowded and chaotic.
“We waited 10 minutes on the phone to get an interpreter, and that is valuable time when we are flooded,” said the resident. “So we started calculating in a utilitarian way and the most conventional patients are the ones that receive the best care.”
Even in a normal situation, people who do not speak English perform worse in a wide variety of routine procedures. They may also have difficulty getting an interpreter. Some studies show that professional interpreters make fewer errors of clinical importance than untrained people, such as family members of the patient.
These gaps increase in times of crisis. ProPublica spoke to 11 New York City medical service employees about their experiences caring for non-English speaking coronavirus patients.
Although they are employed by both high-level, nonprofit institutions in Manhattan and Brooklyn social safety net hospitals, they all described that communication is hastily broken and improvised due to shortages.
They are concerned that language barriers leave covid-19-infected immigrants in a particularly desperate situation: alone, confused, and lacking proper care.
A Bronx doctor described how a colleague, who worked in his organization’s triage tent, tried to evaluate patients using the Google Translate app on his smartphone.
In another situation, the Brooklyn emergency room resident said he knew enough Spanish not to use an interpreter when taking the medical history of an incoming Spanish-speaking patient. Her symptoms were not severe, but she told him that she had had a heart operation three years ago, so she admitted her to the hospital because of that risk factor. Soon after, she realized that the surgery had occurred when the patient was three years old. If he had known, he would have returned her to his home.
Last Sunday, a resident of another Brooklyn hospital treated a woman who spoke only French. The patient’s oxygen mask prevented the interpreter from understanding her, the resident said, and it was clear that the woman remained quite confused. The patient died the following day.
A plant doctor at a Manhattan hospital described how he calls interpreters on his cell phone before entering patient rooms. Then he places the device in his shirt pocket to prevent virus particles from falling, he puts on a yellow protective gown over his uniform and enters the room, keeping his distance from the patient.
All of these steps prevent the patient and the telephone interpreter from hearing each other well. “Then we have to tell them that they have a virus that is killing people around the world,” he added. “We inform them that they cannot have visitors or leave the room, and we close the door on them,” he added.
According to census data, about one in five Americans speaks a language other than English at home. Among New Yorkers, that percentage is 49%. In addition, with more than 40,000 confirmed coronavirus cases in the far reaches of New York City, when residents with poor English proficiency become ill, healthcare providers emphasize the many ways these language gaps could lead to poor care.
Patients who are well enough to go home may misunderstand the instructions when they are discharged, causing them to not properly follow quarantine or to return to the emergency room if their illness worsens. It would also be possible to make mistakes during triage by not detecting underlying conditions.
It has long been understood that the Civil Rights Act of 1964 requires hospitals that receive federal funds (such as Medicare and Medicaid) to provide access to language interpretation. Failure to comply with this guideline is also known as “discrimination based on national origin.” Regulations that came into effect in 2016, when the Affordable Care Act was enacted, reinforced that mandate.
Today, hospitals must use “qualified interpreters” and restrict the use of family members or bilingual but untrained personnel for this work. Patients even have the right to sue the hospital if this is not done (there are exceptions, such as when a family member interprets in full emergency).
Elena Langdon, former director of the National Certification Council for Medical Interpreters, said that she recognizes that at this time doctors may not be able to provide the quality care they would like in all cases, but that equality and right to interpretation. “Although it is more difficult due to the situation, it does not mean that it is not their obligation to do so,” he added. “It is a public health problem,” he stressed.
Langdon said hospitals may need to have staff on staff dedicated to coordinating access to other languages. Several of the hospital systems where the examples of this report occurred did not return our calls, nor did they answer the email in which we asked for comments.
Providers recognized that even in times when there are no pandemics, those guidelines are often not met, such as when a grandchild is allowed to interpret instead of a professional.
However, right now even those options are not available. Many of the city’s hospitals are banning visits, making it impossible for family members who speak English to help patients communicate. In-person interpreters are also at risk of becoming infected or infecting others, and the use of personal protective equipment makes telephone communication difficult.
A nurse in the intensive care unit at a third Brooklyn hospital said that when she needs an interpreter she calls an operator via the long blue cord phone in each room. Then you have to wait for an interpreter to be available, and the wait time varies by language. Spanish is relatively fast, he said; Mandarin takes 10-15 minutes; less common Asian dialects can take up to more than an hour.
Now that visits are banned, this nurse worries that patients will have no one to speak for them and that their family members won’t be able to keep up with them, either. “At this point,” he reported, “we will not call unless we need consent or if the patient dies.”
Last week, a Spanish speaker in his early 40s was admitted to the intensive care unit of the hospital where she works. The patient appeared to be relatively healthy and although he was somewhat overweight, he did not have any underlying medical conditions, the nurse added. Still, this person ended up wearing a respirator soon after.
His wife went to the hospital despite the restriction on visits, but she spoke even less English. “His wife had not been able to see or speak to him,” explained the nurse. “He was just saying, ‘I don’t understand, if it was okay.’ … Part of our nursing work is to approach a family member that we see like this and explain what is happening. But these conversations don’t happen with patients who need interpretation. In that situation, I just don’t have time. ”
“And then he passed away,” he added, “and they had to inform his wife by phone.” She is not sure if the hospital did it through an interpreter or if they simply improvised.
Spanish translation: Mati Vargas-Gibson
Editing and style correction: Mónica de León
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